The process toward fully opening long-term care facilities to visitors and resuming group activities should be done using a gradual, step-by-step approach in order to mitigate the risk of potential COVID outbreaks, according to a leading provider group. 

Activities should first be conducted by wing or unit, and only under the guise of vaccinated workers, for example.

The recommendations were issued in guidance released on Monday by AMDA — The Society for Post-Acute and Long-Term Care Medicine on how providers should approach reopening their facilities as vaccine access becomes more widespread and cases begin to plummet. Last week, provider association LeadingAge called on federal agencies to reconsider its regulations on indoor visitation at nursing homes.

The organization explained that taking a measured approach early will give providers and staff a chance to continuously evaluate what works for residents in a safe manner. 

“Vaccine delays, vaccine hesitancy, admission of new, unvaccinated residents, and ongoing community COVID-19 cases conspire to prolong the threat of COVID-19,” said Christopher Laxton, AMDA executive director. 

“Considering these challenges, facilities must take a thoughtful approach to reopening. In doing so, it should be possible to safely balance the risks of COVID-19 with the negative impact of restrictions in activities and visitation,” he added. 

They recommend beginning group activities among residents within a single unit or wing at a time, with staff who have been vaccinated, as opposed to resuming normal communal functions all at once for the entire building.

Resumptions to group dining and other activities also should include continuously reminding residents about mask wearing, social distancing and hand hygiene. The same should also go for any potential visitors. 

The organization added that the process should closely evaluate the impact the changes have on workflow as part of their quality assurance and performance improvement program. 

“This involves monitoring for new cases of COVID-19 infection in the building and continuous quality improvement around the new processes. Any new COVID-19 infection among staff or residents represents an outbreak and should trigger a return to previous restrictions, in conjunction with guidance from Centers for Medicare and Medicaid Services (CMS) and most states,” the recommendations noted. 

The guidance also calls for providers to: 

  • Encourage all staff, residents and visitors to be vaccinated against COVID-19 and seasonal influenza, 
  • Have staff schedule and supervise all visits with residents, 
  • Continue to screen all visitors for COVID-19 each day they come to the facility, 
  • Require all visitors wear a medical-grade mask issued by the facility at all times, and 
  • Ensure their developed policies and procedures are in accordance with CMS, the Centers for Disease Control and Prevention, local and state requirements.